Standard Scoring Protocol Research Articles

Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening.

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is used worldwide to screen for autism spectrum disorder (ASD). To calculate psychometric properties of the M-CHAT-R/F for subsequent diagnosis of ASD. Systematic searches of Medline, Embase, SCOPUS, and Trip Pro databases from January 2014 to November 2021. Studies were included if they (1) used the M-CHAT-R/F (2) applied standard scoring protocol, (3) used a diagnostic assessment for ASD, and (4) reported at least 1 psychometric property of the M-CHAT-R/F. Two independent reviewers completed screening, full-text review, data extraction, and quality assessment, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A random-effects model was used to derive pooled estimates and assess for between-study heterogeneity. Of 667 studies identified, 15 with 18 distinct samples from 10 countries (49 841 children) were used in the meta-analysis. Pooled positive predictive value (PPV), was 57.7% (95% confidence interval [CI] 48.6-66.8, τ2 = 0.031). PPV was higher among high-risk (75.6% [95% CI 66.0-85.2]) than low-risk samples (51.2% [95% CI 43.0-59.5]). Pooled negative predictive value was 72.5% (95% CI 62.5-82.4 τ2 = 0.031), sensitivity was 82.6% (95% CI 76.2-88.9) and specificity 45.7% (95% CI 25.0-66.4). Negative predictive value, sensitivity, and specificity were calculated based on small sample sizes because of limited or no evaluation of screen-negative children. These results support use of the M-CHAT-R/F as a screening tool for ASD. Caregiver counseling regarding likelihood of an ASD diagnosis after positive screen should acknowledge the moderate PPV.

Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study

To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

Do visual fields need to be considered in classification criteria within visually impaired shooting?

ABSTRACT Classification within the sport of vision impairment (VI) shooting is based upon the athlete’s visual function. This study aimed to determine whether more than one class of competition is needed within VI shooting on the basis of visual field loss. Qualification scores of 23 elite athletes were obtained at World Championship events in prone and standing shooting disciplines. Visual field data were obtained from classification data and from assessment at events. A standardized scoring protocol determined whether athletes had function (≥10 dB) or no function (<10 dB) at locations between 0–60 degrees eccentricity along 10 meridia. Visual field function was not associated with shooting performance in prone or standing disciplines (p > 0.05). Having measurable visual field function beyond 30 degrees made no difference to athletes’ ability to shoot competitively in prone (p = 0.65) or standing disciplines (p = 0.47), although a potential impact on qualification was observed in the standing discipline. There was no evidence that loss of visual field function at any specific location adversely affected ability to shoot competitively. There is currently no evidence to consider visual fields in classification within prone or standing VI shooting, although further research is needed as the sport grows.

An automatic estimation of the rest-interval for MotionWatch8\xa9 using uniaxial movement and lux data

BackgroundPoor sleep is linked with chronic conditions common in older adults, including diabetes, heart disease, and dementia. Valid and reliable field methods to objectively measure sleep are thus greatly needed to examine how poor sleep impacts older adults. Wrist-worn actigraphy (WWA) is a common objective measure of sleep that uses motion and illuminance data to estimate sleep. The rest-interval marks the time interval between when an individual attempts to sleep and the time they get out of bed to start their day. Traditionally, the rest-interval is scored manually by trained technicians, however algorithms currently exist which automatically score WWA data, saving time and providing consistency from user-to-user. However, these algorithms ignore illuminance data and only considered motion in their estimation of the rest-interval. This study therefore examines a novel algorithm that uses illuminance data to supplement the approximation of the rest-interval from motion data.MethodsWe examined a total of 1086 days of data of 129 participants who wore the MotionWatch8© WWA for ≥14 nights of observation. Resultant sleep measures from three different parameter settings were compared to sleep measures derived following a standard scoring protocol and self-report times.ResultsThe algorithm showed the strongest correlation to the standard protocol (r = 0.92 for sleep duration). There were no significant differences in sleep duration, sleep efficiency and fragmentation index estimates compared to the standard scoring protocol.ConclusionThese results suggest that an automated rest-interval scoring method using both light exposure and acceleration data provides comparable accuracy to the standard scoring method.

Filling the gap between microscopic and automated analysis of the tumor-stroma ratio

Determining the tumor-stroma ratio (TSR) using a conventional microscope is an easy to apply and highly reproducible method. Due to digitalization in the pathology workflow, the demand for automated analysis of the TSR method is rising. However, the process of automation is rather time consuming and needs validation before implementation in daily practice. In addition, international studies ask for exchange of digital images instead of the actual slides. This calls for an alternative digital scoring method. This brief report describes the pitfalls of analyzing the TSR using digital images and proposes essential adaptations to create a standardized and reproducible scoring protocol. By using a circular annotation to mimic the microscopic method, these pitfalls can be avoided. Scoring the TSR digitally using a circular annotation does not take much additional effort compared to the microscopic method. When a fixed size of the annotation is saved, new cases can be scored in less than two minutes. With this brief report we propose an adjusted method for scoring the TSR on digital images to fill the gap between microscopically and automated scoring of the TSR. In addition, it opens the opportunity for application in daily diagnostics.

Abstract P2-03-01: Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration

Abstract Aims: (i) Determine whether between-observer reproducibility for Ki67 when assessed on whole sections according to a standardized scoring protocol is adequate for clinical application. (ii) Compare between-observer reproducibility of Ki67 scores assessed on hot-spots to scores using a global method that averages across a tissue section. Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including aiding decisions based on prognosis, but unacceptable levels of between-laboratory variability have been observed. The International Ki67 in Breast Cancer Working Group has undertaken a systematic program to determine whether Ki67 measurement can be analytically validated and standardized across labs. In phase 1, variability in visual interpretation was identified as an important source of variability. Phases 2 and 3a showed that adherence to defined scoring methods substantially improved reproducibility in scoring tissue microarrays and core-cut biopsies. We now assess whether acceptable reproducibility can be achieved on whole sections. Methods: Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 to assemble 4 sets of 30 stained tumor sections, circulated around 23 labs in 12 countries. Ki67 was scored by 2 methods by all labs: (a) global: 4 fields of 100 tumor cells each were selected to reflect observed heterogeneity in nuclear staining (b) hot-spot: the field with highest Ki67 percentage of tumor cells with nuclear staining was selected and up to 500 cells scored. Ki67 scores were log2-transformed for statistical analyses and back-transformed for presentation. The primary objective was to assess whether either method could achieve an intraclass correlation coefficient (ICC) significantly greater than 0.8, considered substantial to almost-perfect reproducibility. Secondary objectives were to assess which method had highest observed ICC and to assess whether observers identified the same “hot-spots”. Results: ICC for the global method was 0.87 (95%CI: 0.799-0.93), marginally meeting the prespecified success criterion. The ICC for the hot-spot method was 0.83 (95%CI: 0.74-0.90) and had a CI extending below the success criterion. Across the 23 labs, geometric mean value of the 30 scores ranged from 8.5 to 19.6 for the global method and from 12.8 to 30.3 for the hot-spot method. The overall mean (95% CI) of these values was 12.9 (11.9-14.0) and 20.9 (19.1-22.8), respectively. Visually, between-laboratory agreement in location of selected hot-spot varies between cases. The median times for scoring were 9 and 6 minutes for global and hot-spot methods respectively. Conclusions: The global method marginally met the prespecified criterion of success; it should now be evaluated for clinical validity in appropriate cohorts of cases. The hot-spot method was observed to have slightly less reproducibility between labs. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between labs further. (Supported by a grant from the Breast Cancer Research Foundation) Citation Format: Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm A-V, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-03-01.

Invitro evaluation of a new iterative reconstruction algorithm for dose reduction in coronary artery calcium scoring.

BackgroundCoronary artery calcium (CAC) scoring is a widespread tool for cardiac risk assessment in asymptomatic patients and accompanying possible adverse effects, i.e. radiation exposure, should be as low as reasonably achievable.PurposeTo evaluate a new iterative reconstruction (IR) algorithm for dose reduction of in vitro coronary artery calcium scoring at different tube currents.Material and MethodsAn anthropomorphic calcium scoring phantom was scanned in different configurations simulating slim, average-sized, and large patients. A standard calcium scoring protocol was performed on a third-generation dual-source CT at 120 kVp tube voltage. Reference tube current was 80 mAs as standard and stepwise reduced to 60, 40, 20, and 10 mAs. Images were reconstructed with weighted filtered back projection (wFBP) and a new version of an established IR kernel at different strength levels. Calcifications were quantified calculating Agatston and volume scores. Subjective image quality was visualized with scans of an ex vivo human heart.ResultsIn general, Agatston and volume scores remained relatively stable between 80 and 40 mAs and increased at lower tube currents, particularly in the medium and large phantom. IR reduced this effect, as both Agatston and volume scores decreased with increasing levels of IR compared to wFBP (P < 0.001). Depending on selected parameters, radiation dose could be lowered by up to 86% in the large size phantom when selecting a reference tube current of 10 mAs with resulting Agatston levels close to the reference settings.ConclusionNew iterative reconstruction kernels may allow for reduction in tube current for established Agatston scoring protocols and consequently for substantial reduction in radiation exposure.

Analytical validation of a standardized scoring protocol for Ki67: phase 3 of an international multicenter collaboration.

Pathological analysis of the nuclear proliferation biomarker Ki67 has multiple potential roles in breast and other cancers. However, clinical utility of the immunohistochemical (IHC) assay for Ki67 immunohistochemistry has been hampered by unacceptable between-laboratory analytical variability. The International Ki67 Working Group has conducted a series of studies aiming to decrease this variability and improve the evaluation of Ki67. This study tries to assess whether acceptable performance can be achieved on prestained core-cut biopsies using a standardized scoring method. Sections from 30 primary ER+ breast cancer core biopsies were centrally stained for Ki67 and circulated among 22 laboratories in 11 countries. Each laboratory scored Ki67 using three methods: (1) global (4 fields of 100 cells each); (2) weighted global (same as global but weighted by estimated percentages of total area); and (3) hot-spot (single field of 500 cells). The intraclass correlation coefficient (ICC), a measure of interlaboratory agreement, for the unweighted global method (0.87; 95% credible interval (CI): 0.81–0.93) met the prespecified success criterion for scoring reproducibility, whereas that for the weighted global (0.87; 95% CI: 0.7999–0.93) and hot-spot methods (0.84; 95% CI: 0.77–0.92) marginally failed to do so. The unweighted global assessment of Ki67 IHC analysis on core biopsies met the prespecified criterion of success for scoring reproducibility. A few cases still showed large scoring discrepancies. Establishment of external quality assessment schemes is likely to improve the agreement between laboratories further. Additional evaluations are needed to assess staining variability and clinical validity in appropriate cohorts of samples.

Abstract P1-01-01: Analytical validation of a standardized scoring protocol for Ki67: Phase-3 of an international multicenter collaboration

Abstract Aims: (i) To determine if between-pathologist agreement for Ki67 is adequate for clinical application, following a standardised scoring protocol. (ii) To compare between-pathologist agreement of scoring hot-spots vs a global method averaging Ki67 across each section. Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including aiding decisions based on prognosis, but has unacceptable between-laboratory variability. The International Ki67 Working Group has undertaken a systematic program to determine whether Ki67 measurement can be analytically validated and standardized across labs. In phase 1 variability in visual interpretation was the most important source of variability. Phase 2 showed that significant improvements in agreement could be achieved when scoring the same tumors on tissue microarrays by following clearly defined scoring methods. We now assess whether acceptable performance can be achieved on core-cut biopsies using a standardised method. Methods: Three adjacent sections from each of 30 primary ER+ breast cancers were centrally stained for Ki67 to assemble three sets of 30 stained tumor sections, circulated around 22 laboratories in 11 countries. Ki67 was scored by 2 methods by all labs: (a) global: 4 fields of 100 cells each were selected to represent any heterogeneity (b) hotspot: the field with highest Ki67 staining percentage was selected and 500 cells scored. Ki67 scores were log2-transformed for statistical analyses and back-transformed for presentation. The primary objective was to assess if either method could achieve an intraclass correlation coefficient (ICC) significantly greater than 0.8, considered substantial to almost-perfect agreement. Secondary objectives were to assess which method had highest observed ICC and to assess whether pathologists identified the same "hotspots". Results: The ICC for the global method was 0.88 (95%CI: 0.81-0.93) and therefore met the prespecified success criterion. The ICC for the hotspot method was 0.84 (95%CI: 0.77-0.92) and therefore had a CI which extended below the success criterion. Across the 22 labs, geometric mean value of the 30 scores ranged from 14.4 to 27.9 for the global method and from 17.4 to 40.2 for the hotspot method. The overall mean (95% CI) of these values was 19.8 (18.5-21.3) and 26.4 (24.6-28.3), respectively. Visually, there was moderately strong agreement in location of selected hotspot in the core-cuts across laboratories. The impact of variability of the Ki67 scores for estimating prognosis using the integrated IHC4 + clinical treatment score will be assessed. After selection of the areas to score, the median times for cell counting were 3 and 4 minutes for the global and hotspot methods, respectively. Conclusions: The global method met the prespecified criterion of success; it should now be evaluated for clinical validity in appropriate cohorts of samples. The hotspot method showed slightly less agreement between labs. The time taken for scoring is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the agreement between labs further. (Supported by a grant from the Breast Cancer Research Foundation). Citation Format: Dowsett M, Leung SCY, Zabaglo L, Arun I, Badve SS, Bane AL, Bartlett JMS, Borgquist S, Chang MC, Dodson A, Enos RA, Fineberg S, Focke CM, Gao D, Gown AM, Grabau D, Gutierrez C, Hugh JC, Kos Z, Lænkholm A-V, Lin M-G, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Viale G, Hayes DF, McShane LM, Nielsen TO. Analytical validation of a standardized scoring protocol for Ki67: Phase-3 of an international multicenter collaboration. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-01.

HENT1 expression is predictive of gemcitabine outcome in pancreatic cancer: a systematic review.

High human equilibrative nucleoside transporter 1 (hENT1)-expression has shown a survival benefit in pancreatic cancer patients treated with gemcitabine in several studies. The aim of this systematic review was to summarize the results and try to assess the predictive value of hENT1 for determining gemcitabine outcome in pancreatic cancer. Relevant articles were obtained from PubMed, Embase and Cochrane databases. Studies evaluating hENT1-expression in pancreatic tumor cells from patients treated with gemcitabine were selected. Outcome measures were overall survival, disease-free survival (DFS), toxicity and response rate. The database searches identified 10 studies that met the eligibility criteria, and a total of 855 patients were included. Nine of 10 studies showed a statistically significant longer overall survival in univariate analyses in patients with high hENT1-expression compared to those with low expression. In the 7 studies that reported DFS as an outcome measure, 6 had statistically longer DFS in the high hENT1 groups. Both toxicity and response rate were reported in only 2 articles and it was therefore hard to draw any major conclusions. This review provides evidence that hENT1 is a predictive marker for pancreatic cancer patients treated with gemcitabine. Some limitations of the review have to be taken into consideration, the majority of the included studies had a retrospective design, and there was no standardized scoring protocol for hENT1-expression.

Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

Growth, training response and health in Standardbred yearlings fed a forage-only diet

The aim of this study was to, from a holistic perspective, describe the effects of a forage-only feeding system and a conventional training program on young Standardbred horses and compare data with similar observations from the literature. Sixteen Standardbred colts fed a forage-only diet for 4 months from breaking (August to December) and with the goal to vigorously trot 5 to 7 km at a speed of 5.6 m/s (3 min/km) were studied. The horses were fed grass haylage (56 to 61% dry matter (DM), 2.80 to 3.02 Mcal DE/kg DM and 130 to 152 g CP/kg DM) ad libitum, 1 kg of a lucerne product and minerals. The amount of training and number of training sessions were documented daily, and feed intake and body development were measured once every month. Heart rate (HR) was measured during and after a standardized exercise test in October and December. In December, a postexercise venous blood sample was collected and analyzed for plasma lactate concentration. Muscle biopsies (m. gluteus medius) were taken and analyzed for glycogen and fiber composition. Health was assessed in October and November by an independent veterinarian using a standardized health scoring protocol. BW and height at withers increased from 402 to 453 kg (root mean square error (RMSE) 6) and from 148.7 to 154.1 cm (RMSE 0.7), respectively, and the body condition score was 4.9 (RMSE 0.2) at the end of the study. Muscle glycogen content was 532 mmol/kg dry weight (s.d. 56). There was a significant decrease in postexercise HR (81 v. 73 bpm, RMSE 8), and the individual amount of training was negatively correlated with HR during and after exercise. Health scores were high and similar at both assessments (8.4 and 8.4 (RMSE 1.0) out of 10; P > 0.05), and the number of lost training days per month due to health problems was <0.9, with the exception of November (5.3 days). It is concluded that yearlings in training fed high-energy forage ad libitum can reach a conventional training goal and grow at least as well as earlier observations on yearlings of other light breeds.

Recombinant IgG Fc Fragments Effectively Suppress Experimental Myasthenia Gravis (S35.002)

Objective: To investigate the therapeutic effects of intravenous administration of fully recombinant forms of polyvalent IgG Fc fragments in murine experimental myasthenia gravis. Background Intravenous immune globulin (IVIg) has been shown to have broad therapeutic application in the treatment of autoimmune diseases, including myasthenia gravis (MG). The anti-inflammatory activities of IVIg are now generally attributed to the immunoglobulin G (IgG) Fc domains. Interestingly, soluble immune aggregates bearing intact Fc fragments have been shown to be effective in the treatment of a variety of autoimmune disorders in mice. To study the mechanisms by which soluble Fc containing immune complexes can suppress autoimmunity, a series of fully recombinant forms of polyvalent IgG2a Fc were created by linking the hinge-CH2-CH3 regions of murine IgG2a Fc to one or more multimerization domains (MD). Design/Methods: Recombinant polyvalent IgG2a fusion proteins (400µg) were administered via tail vein to mice with well-established experimental myasthenia gravis (EAMG) on five consecutive days. Control EAMG mice received a) IVIg (0.4 g/kg) X 5 days or b) PBS. Effectiveness of treatment was assessed by improvement in myasthenic weakness as determined by a standard clinical scoring protocol, circulating serum levels of anti-AChR antibodies, and immunological evaluation of lymph nodes and spleens. Results: Treatment of EAMG mice with recombinant polyvalent IgG2a Fc fusion proteins produced a significant improvement in myasthenic weakness, and an equivalent magnitude of beneficial effect compared to IVIg. Results of anti-AChR antibody levels and immunological studies of splenocytes and lymph node cells will be presented. Conclusions: Recombinant polyvalent IgG2a Fc fusion proteins were equally effective in ameliorating EAMG compared to IVIg, and may represent a feasible alternative, offering the advantages of being completely recombinant, of unlimited supply, free of infectious risks, and effective at doses 1 -2 log orders lower than IVIg. Supported by: The NIH (National Institute of Neurologic Disorders and Stroke, K08NS058800, and the Muscular Dystrophy Association (MDA) MNM and JRS; and National Institute of Allergy and Infectious Diseases, RO1 AI 058190, BSP. Study material (Recombinant IgG2a Fc fusion proteins (stradomersTM) was provided by Gliknik, Inc. Disclosure: Dr. Meriggioli has received personal compensation for activities with Athena Diagnostics, Talecris Biotherapeutics, Gliknik, and Celegene Corporation. Dr. Meriggioli receives patent payments for a patent on bispecific antibody coated dendritic cells. Dr. Meriggioli has received research support from the NIH/NINDS and the Muscular Dystrophy Association. Dr. Sheng has nothing to disclose. Dr. Li has nothing to disclose. Dr. Muthusamy has nothing to disclose. Dr. Prabhakar has received personal compensation for activities with Gliknik Inc. as a consultant.Dr. Prabhakar has received research support from NIH.

Suppression of EAE and prevention of blood–brain barrier breakdown after vaccination with novel bifunctional peptide inhibitor

The efficacy of bifunctional peptide inhibitor (BPI) in preventing blood–brain barrier (BBB) breakdown during onset of experimental autoimmune encephalomyelitis (EAE) and suppression of the disease was evaluated in mice. The mechanism that defines how BPI prevents the disease was investigated by measuring the in vitro cytokine production of splenocytes. Peptides were injected 5–11 days prior to induction of EAE, and the severity of the disease was monitored by a standard clinical scoring protocol and change in body weight. The BBB breakdown in diseased and treated mice was compared to that in normal control mice by determining deposition of gadolinium diethylenetriaminepentaacetate (Gd-DTPA) in the brain using magnetic resonance imaging (MRI). Mice treated with PLP-BPI showed no or low indication of EAE as well as normal increase in body weight. In contrast, mice treated with the control peptide or PBS showed a decrease in body weight and a high disease score. The diseased mice had high deposition of Gd-DTPA in the brain, indicating breakdown in the BBB. However, the deposition of Gd-DTPA in PLP-BPI-treated mice was similar to that in normal control mice. Thus, PLP-BPI can suppress EAE when administered as a peptide vaccine and maintain the integrity of the BBB.

Evaluation of malingering cut-off scores for the Rey 15-Item Test: a brain injury case study series

Primary objective : To evaluate the utility of prescribed malingering cut-off scores by examining the Rey Fifteen-Item Test (FIT) responses of persons with severe brain injury. Research design : Series of five case studies. Methods and procedures : The FIT was administered along with standardized neuropsychological and neurobehavioural meausres. Main outcomes and results : Using the standardized scoring protocol, all five patients obtained perfect (15/15 correct) scores on the FIT. All patients exhibited significant impairment on other neuropsychological indices, included measures of memory and attention. Conclusions : Results lend support to the use of higher cut-off scores to identify malingering. Further large-scale research is recommended to ascertain the reliability of FIT scoring procedures, determine cut-off scores for various diagnostic groups and develope age and education adjustments. Implications for use of the FIT in clinical and forensic settings are also discussed.

The long-term effects of rally driving on spinal pathology

Objectives. To investigate the consequences of rally driving on lumbar degenerative changes. Background. Vehicular driving is suspected to accelerate disc degeneration through whole-body vibration, leading to back problems. However, in an earlier well-controlled study of lumbar MRI findings in monozygotic twins, significant effects of lifetime driving on disc degeneration were not demonstrated. Another study of machine operators found only long-term exposure to vibration on unsprung seats led to a reduction in disc height. Design. Case-control study comparing rally drivers with population sample. Methods. Eighteen top rally drivers and co-drivers, mean age 43 yrs (SD, 10), volunteered for the study. The subjects were interviewed and imaged with a MR scanning and lumbar images were analyzed for degenerative findings using a standard scoring protocol previously published. The reference group was composed of 14 men, mean age 55 yrs (SD, 10), selected from a population sample. Results. Overall results showed no significant differences in lumbar degenerative findings as assessed from MR images between the rally drivers and the reference group; age-adjusted differences were not statistically significant for disc heights, bulges, herniations, end-plate irregularities, or osteophytes. Conclusion. Even extreme vehicular vibration as experienced in rally driving does not appear to have significant effects on disc generation. Relevance The study results do not support driving, and its associated whole body vibration, as a significant cause of disc degeneration and question the theory that the higher incidence of back pain among drivers is due to accelerated disc degeneration. Other driving-related factors, such as postural stress, may deserve more attention.

A computer program for automated scoring of exteroceptive suppression periods

Exteroceptive suppression (ES) of temporalis muscle activity has received recent attention as a method of investigating central mechanisms in the pathogenesis of chronic headache disorders. Unfortunately, the resolution of conflicting findings has been hampered by the use of different assessment and scoring methodologies across laboratories, which has limited the direct comparison of findings across studies. A computer program was developed with the goal of providing an automated and reliable method of scoring ES responses. Processing an ES response with this software provides both visual and quantitative information relating to various response parameters. Multiple levels of smoothing the raw waveform data are available, and the software offers scoring on the basis of multiple depth-of-suppression criteria. The program also generates values for a variety of ES parameters: latency, duration, area, maximum level of suppression with its corresponding time (msec), and baseline level of muscle activity. It is likely that a reliable and standardized scoring protocol would enhance comparability of ES data generated across different settings.

Assessment of oral storytelling abilities of Latino junior high school students with learning handicaps.

This study investigated the relationship between reading comprehension and oral storytelling abilities. Thirty-one Latino junior high school students with learning handicaps were selected as subjects based on learning handicapped designation, home language, and language proficiency status. Reading comprehension was measured by the Reading Comprehension subtest of the Peabody Individual Achievement Test. Storytelling was measured by (a) the Oral Production subtest of the Language Assessment Scales using the standard scoring protocol and (b) a story structure analysis. A comparison of the standard scoring protocol and reading comprehension revealed no relationship, while the comparison of the story structure analysis and reading comprehension revealed a significant correlation. The implications of these results for language assessment of bilingual students are discussed.